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Welcome!

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Tracy’s health counseling certification is from Columbia University for the Institute of Integrative Nutrition in New York.

She has completed ongoing training and is working on a certification in understanding the root causes of chronic illness with the Institute of Functional Medicine and on an additional Masters degree in Human Nutrition at Bridgeport University.

She holds a Masters degree in Engineering from MIT and a Masters degree in Management from The Sloan School at MIT.

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Understanding Allergies and Asthma

Part 1

This presentation is copyrighted by Purpose Inc. with all rights reserved, available for student reuse strictly subject to the terms outlined in the SAFM student program agreement.

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● Key Reminders● An Introduction to Immunity● Inflammation: Pulling it all Together● The Role of the Gut● Allergy

– Definitions

– Biochemistry

– Triggers/Root Causes

– Treatment/Testing

● More Information

Agenda

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Optimal Health is Not Complicated

Maximize Put in what’s needed for this unique person

Raw materials your body needs to function and heal Oxygen, Water, Vitamins, Minerals, Antioxidants, Protein, Healthy Fats Belief that the therapy one is choosing is effective and safe

MinimizeTake out what’s harmful for this unique person

Toxins, Infections, Allergens, Stress, TraumaLimiting beliefs, fear, negative expectations

PrioritizeCreate an environment for healing for this unique person

Sleep, Rest, Laughter, Stress ReductionExercise, Stretching, BreathingMeaningful RelationshipsPositive visualizations and associations

And then the body will heal itself – will naturally seek wellness.

Simplifying the face of health can be very calming and inspiring to

your clients.

Of course, we are not very good at doing these three things consistently. The result? Chronic Dis-ease in the body.

This is Why Your Clients and Patients Need You!

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An Introduction to Immunity

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What is Healthy Immunity?

Detective & Defensive– Identifies potentially threatening molecular structures:

stranger signals– Mounts responses appropriate to level of threat: danger signals

Internally Regulated– Immune responses are tightly controlled & actively resolved by

multiple mechanisms

Restorative– Repairs damage that ensues from injury or adversarial encounters

Tolerant: Actively unresponsive to– Self (e.g. enzymes, tissues)– Innocuous microbial antigens

(commensal species)– Food and environmental antigens

With appreciation to Dr. Bob Roundtree, Institute of Functional Medicine

Generally, a Healthy Immune system's job is

to surveil and then NOT react.

Primarily Tolerance.

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What is Healthy Immunity?

Strong, non-specific barrier function is an example of innate immunity in action.

An Antigen is something that triggers an immune response.

A Pathogen is something capable of causing dis-ease in the body.

VirusYeast

Chemical

BacteriaParasite

Toxin

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Innate and Adaptive Immunity

With appreciation to Dr. Bob Roundtree, Institute of Functional Medicine

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White Blood Cells: Our Soldiers

Innate Immunity (Rapid Response)

Adaptive Immunity (Slower Response)

Humoral Immunity Cell-Mediated

Immunity

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Innate Immunity

With appreciation to Dr. Bob Roundtree, Institute of Functional Medicine

Innate immunity is part of all plant, insect, and animal defense systems.

Repels pathogenic invaders with an immediate response and controlled inflammation.

Central coordination of all immune response Requires no prior exposure to the threat Active from first exposure up to 96 hours Can be non-induced (e.g. physical or chemical barriers) or induced which is

focused on eating up potential threats – quickly.– Granulocytes

(neutrophils, basophils, eosinophils)

– Macrophages(activated monocytes)

– Natural killer cells

– Mast cellsMacrophage

= “Big Eater”

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Innate Immunity

Recruits more immune cells to site of infection. Sentinels – primarily dendritic and B cells –

are the key interface between innate and adaptive immunity.

– Constantly “sample” what is in our environment (especially in our gut).– Serve up on a platter (literally)a chewed up bit of what it's found WITH an opinion

about it (various cytokines and “co-stimulatory factors”).

– Commune with T lymphocytes totell them how to react.

– Two Factors: Stranger & Danger.

T cells then Activate and determine the Adaptive response

– React (cell-mediated immunity – Th1)– React (humoral immunity – Th2)– Freak out (very inflammatory -Th17)– Relax (calm immune system - Treg)

Infla

mm

atio

n

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Adaptive “Dynamic Duo”: Th1 and Th2

The adaptive immune system is specific, identifying and eradicating specific threats based on their molecular profile (e.g. Epstein-Barr virus vs. general “virus” category that the innate immune system would respond to).

– Enacted via T and B lymphocytes (named for where they mature).

– One must be “exposed” to the threat in order to react to it.

– Takes 4+ days to “ramp up” for peak effectiveness.

Th1 (cell-mediated) and Th2 (humoral): the two arms of Adaptive immunity.

– Th1 triggers primarily macrophages to respond tointracellular threats (e.g. virus, cancer cells).

– Th2 triggers primarily B cells to produce antibodies in response to extracellular threats (e.g. parasites).

Humoral Immunity. B cells carry protein-specific receptors. When bound to its antigen and co-activated by a mature T cell, B cells can transform into 2 cells:

– Plasma B cells: make antibodies– Memory B cells: hold long-term antigen memory

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Humoral Immunity: Antibodies

Antibodies are like immune Red Flags. They bind to antigens and attract destructiveimmune system reactions.

– Only certain portions (usually a protein or carbohydrate)of an antigen (epitopes) bind with an antibody.Each epitope can have an antibody, and there may be several reacting at once.

Five antibodies types of Adaptive Immune System: IgA, IgD, IgE, IgG, and IgM. Antibodies attract other immune cells (e.g. neutrophils, macrophages) or the

Complement system (e.g. cytolysis) in order to dispose of flagged threats. Purpose Inc.©

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Antibody Protection

Protects tissues

Protects bloodstream

Protects mucous membranes

Protects entire organism (gatekeeper)

With appreciation to Dr. Kara Fitzgerald, Institute of Functional Medicine

IgG antibodies (75% of total) form complexes with antigens (half-life: 3-21 days). IgE antibodies (<0.01% of total) attach to mast cells and triggers histamine

release when it encounters its antigen (half-life: 2-3 days). IgA antibodies (~20% of total) are particularly important in the gastrointestinal

lining defense system (half-life: 6 days).

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Pulling it All Together: Inflammation

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A Different Perspective

Most immune function in the human body occurs without your knowledge.

Inflammation you can observe is a sign of more intense or extended immune system activation. Remember: Inflammation is a sign of Loss of Tolerance.

Your Body asking for Help from cell to cell - and perhaps from “you” too.

Flu symptoms aren't caused by the influenza virus. They are caused by your immune system in its effort to identify, contain, and eradicate the threat.

How and When do we respond to Inflammation?– Ignore it and “just keep going”?

– Pop a pill (or 2 or 3 or 4) to suppress the annoying symptoms?

– Take a day off from work, drink plenty of liquids, take some extra zinc, andgo back to bed?

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Inflammation & Cellular Communication

Inflammation is the body’s response to threat or injury. Necessary for triage and survival. e.g. wound-healing (swelling, redness, fever)

Cells secrete chemicals (e.g. cytokines)which communicate the need to Calm the body (anti-inflammatory) or Alarm the body (inflammatory)

Harmful if Chronic or Inappropriate

The most common chronic inflammation triggers: food, bugs, toxins, stress. Common chronic inflammatory symptoms are often what our clients think of as

“just getting old”! e.g. swollen joints, achy muscles, congestion, headaches, diarrhea, constipation, GERD,

depression, lethargy, ongoing fatigue, skin rashes, itchiness, bloating, poor memory, irritability, brain fog

But they become things we know to be highly-debilitating or deadly Diabetes, Atherosclerosis, Asthma, Multiple Sclerosis, Alzheimers, Cancer…

Generally, Inflammation means a loss of Tolerance.Purpose Inc.©

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With appreciation to Dr. Dan Lukauzer, Institute of Functional Medicine, AFMCP

An example:

Dairy foods

FHx: low Vit. D

Low Omega-3s and Zinc

Stuffy nose

“Allergic Rhinitis”

An example:

Laundry detergent

FHx: Poor methylation

Low vegetable intake (folate)

Itchy, scaly, bumpy skin

“Dermatitis” (Chronic Eczema)

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Immune Imbalance

Balance, Tolerance Dysbiosis

Allergy, Atopy

Autoimmune Disorder

Chronic/Severe Infection

Increasing Immune Dominance

(Over-reactive)

Increasing Pathogen Dominance

(Under-reactive)

e.g. lupus eczema wellness IBS (SIBO) hepatitis celiac asthma toe fungus candida M/S itchy lips “always have a cold” atherosclerosis

An ideal immune system is appropriately Tolerant.

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The Role of the Gut in Immunity

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The Wild Frontier

● The GI tract is essentially “outside” of the body, like the hole in a doughnut.It's an exchange area where– Nutrients come in– Toxins and foreign invaders are kept out– Wastes are deposited for excretion– The body SENSES our environment

● The critical lining of all cavities in theGI tract has a vital role of separating the Good from the Bad.

● 2/3+ of our entire immune system is just below the preciousmucosal gut lining. If it is damaged, we are less well-protected.– In the stomach: gastritis or microbial infection or protein deficiency– In the intestines: malnutrition or “leaky gut” (intestinal permeability)– In the colon: diverticulitis or constipation or toxin reabsorption

● What happens in the gut affects the rest of the body!– Not just Nutrient intake/deficiency but Inflammation

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Who's the Host?

● We have hundreds of trillions of microbes within us! Together they are thelargest “organ” in the GI tract (~ 4 lbs).

● Approximately 500 different species – bacteria, yeast, fungus, parasites - allcompeting for space and food and nutrients.– It is normal (and well-tolerated in most people) to have small amounts of potentially

pathogenic microbes (e.g. H. Pylori, C. Albicans)

● These microbes eat residue from our diet (e.g. fiber, sugars, maldigested proteinor starches) & secrete vitamins, beneficial fats (SCFAs), and (sometimes) toxins.

● Toxic microbe overgrowth (e.g. Clostridia difficile, Helicobacter Pylori, CandidaAlbicans) can break down our mucosal layer, while beneficial bacteria (e.g.lactobacillus) build it up.

● Balanced bacteria in our gut help to keep the immune system calm and not over-reactive (e.g. allergy, asthma, arthritis, and all autoimmune disorders).

– Helps maintain integrity of intestinal lining and prevent increases in intestinalpermeability (aka leaky gut).

– Educate the immune system about the difference between friend and foe microbes.

– Balance Th1 (innate) and Th2 (adaptive) immune responses.

Our health depends on the health of our microbial

partners: beneficial bacteria

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“The [G.I.] mucosa is directly exposed to the external environment and taxed with antigenic loads consisting of commensal bacteria, dietary antigens, and viruses at far greater quantities on a daily basis than the systemic immune system sees in a lifetime.”*

And remember: 99.99% of the time, the job of the immune system is to Tolerate - and NOT respond.

* Mayer L. Mucosal Immunity. Pediatrics 2003;111:1595-1600.

Our Overworked Police Force

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Inflammation (often!) Begins in the Gut

Just beneath a single-cell-thick epithelial layer in the gut lies the GALT (Gut-Associated Lymphatic Tissue), the immunity “police station”

Pathogenic microbes (e.g. parasite, bacteria, yeast)– Perhaps compounded by toxins secreted by the microbes

Dysbiosis (an imbalance in indigenous, human gut bacteria OR species of bacteria in the wrong place in the gut)

Food (that looks a little too much like a toxin, allergen, or foreign invader e.g. GMO foods including 90+% of non-organic soy and corn grow in the US)

Toxins (e.g. pesticides, Red #40, birth control pills, artificial sweeteners, toothpaste, mercury, alcohol)

Leaky gut (intestinal permeability) which can cause any or all of these things to get deeper into the lymphoid tissue of the gut (or even leak into our blood supply). Triggering a strong immune response.

Persistent inflammatory triggers release NF-KappaB which ups immune reactivity and intensity

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Intestinal Permeability

Potential Triggers/Causes● Low Vitamin D● NSAID drugs● Rx Drugs

(e.g. SSRI,birth control pills,chemotherapy,radiation)

● Antibiotics● Gut microbial imbalance● Pathogens (e.g. Candida)● Isolation from “old friends”*● Gluten (zonulin)● Stress● Highly processed foods● Toxins

* http://www.sciencedaily.com/releases/2012/10/121003082734.htm

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Etiology of Inflammatory Dis-Ease

Dysbiosis

Infection

Food sensitivities

Toxins

Inflammation Arthritis

Eczema

Asthma/Allergy

Psoriasis

Chronic Fatigue

Fibromyalgia

Chronic PND, headache, muscle pain, etc.

BUT there may be no GI symptoms whatsoever!

Tendonitis

Cancer

Atherosclerosis

Auto-immune disease

e.g. TNF-αIL-1IL-6IFN-γCRPESR

Genetic Expression

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Fundamentals of Allergy

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Defining Allergy

An abnormally high sensitivity to a substance which is not usually harmful to humans

A damaging immune response caused by a substance to which one has become hypersensitive

An inflammatory response to a typically innocuous environmental substance (e.g. food, pollen, insect venom, plant, medication, supplement, chemical)

A confused, overwrought immune system A hypersensitivity disorder of the immune system

Symptoms can be anything from mildly irritating to life-threatening. Formally, “allergy” is type 1 or 2 hypersensitivity. From a few seconds to many

hours to noticeably manifest (e.g. peanuts or poison ivy). “Atopy” is a formal diagnosis of a tendency to be hyperallergic.

Generally, Inflammation means a loss of Tolerance.Purpose Inc.©

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Allergic Reactions

● Allergic response is caused bya release ( or “degranulation”) of histamine and inflammatory mediators(e.g. cytokines, prostaglandins, leukotrienes, interleukins).

● Impact on tissue may be localized (e.g. eczema) orsystemic (e.g. body-wide hives, anaphylactic shock).

● Histamine causes leakage of fluid from smallblood vessels into tissue and muscle contraction.

● Typical symptoms include itchiness,swelling of mucous membranes, increasedproduction of mucus, muscle contraction/spasm,low blood pressure, skin inflammation.

● Inflammatory symptoms usually persist afterthe initial “acute phase” as the immune systemhas release a rich mix of inflammatory chemicalsand has also recruited more supportfrom innate response cells.

● May be environment- or circumstance-sensitive (e.g. high stress, cooked vs. raw).

For example: an allergic reaction to penicillin (a drug)

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Biochemistry of Type 1 Allergy

First exposure sensitizes.

Repeat exposure triggers a faster and more aggressive reaction.

Chronic exposure impairs barriers can increase exposure and may also expand sensitivity to more antigens.

Remember: “Allergy” isn't a foreign immune response but an inappropriate one. ** http://www.researchgate.net/publication/10661042_The_Gell-Coombs_classification_of_hypersensitivity_reactions_a_re-interpretation/file/9c9605177e68386d5d.pdf

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Common Allergies

● Foods (90% of food allergies involve these): Dairy, Eggs, Peanuts,Wheat, Soy, Fish, Shellfish, Tree nuts, Corn

● Organisms (e.g. Mold, Dust Mites)● Plants/Pollen (e.g. trees, grasses, ragweed)● Chemicals (e.g. Latex)● Medications (e.g. certain antibiotics)● Pet Dander (e.g. dog, cat)● But there can be very unusual ones too...

– Topical progesterone

– Silk

– Sunshine

– EMF (e.g. cell phone)

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Allergic Predisposition: Potential Factors

● Remember key sources of inflammation from the gut (e.g. food, toxins,microbes, and intestinal permeability) will play a significant role.

● But there are many potential contributors....– Family history**– Excessive hygiene– Vaccination ***– Birth by C-section– Environmental toxin exposure– Low Vitamin D*– Nutrient Deficiencies*****

(Vitamin A, Zinc, Omega-3s)

* http://www.sciencedaily.com/releases/2010/03/100307215534.htm** http://www.ncbi.nlm.nih.gov/pubmed/19853353 and http://www.jiaci.org/issues/vol19s1/5.pdf *** http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448377/**** http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2957505/***** http://www.sciencedirect.com/science/article/pii/S0091674905012741

– Not being breast-fed as infant

– High antibiotic use

– High NSAIDS or other medication use– Other compromised barriers

e.g. skin ****– Pesticides, GMO, high-additive foods– Ongoing mental/emotional stress– Low adrenal function

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Childhood Food Allergies: A Perfect Storm?

“We propose a "multiple-hit" model in which

[vitamin D deficiency] in a developmentally critical period increases susceptibility to

colonization with abnormal intestinal microbial flora and gastrointestinal infections,

contributing to abnormal intestinal barrier permeability

and excessive and inappropriate exposure of the immune system to dietary allergens.” *

- Dr. MF Vassallo et al, Harvard Medical School, 2010

* http://www.ncbi.nlm.nih.gov/pubmed/20624647

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Testing and Diagnosis

● Allergies– Skin or “prick” testing for immediate IgE reactions

– Patch testing for delayed IgE reactions

– Blood testing for specific IgE antibodies

● Total blood levels of IgE antibodiescan indicate overall sensitization

– Oral challenge testing for IgE reactions (rare)

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Typical Management Treatment

● IgE Allergies

– Steroids (e.g. Prednisone)

– Antihistamine (e.g. Zyrtec, Benadryl)

– Leukotriene antagonist (e.g. Singulair)

– Epinephrine (e.g. Epi Pen, emergency rescue only)

– Desensitization therapy (e.g. injections, eventual touch therapy, oralchallenge)

● IgE Allergies and IgG Sensitivities

– NSAID anti-inflammatory agents (e.g. Advil, Motrin, Fioricet)

● But there are many natural alternatives – stay tuned in Part 2.

– Quercetin, Curcumin, Omega-3s, Boswellia, Bromelain, Probiotics....

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Other Reactions to Food

● Not all physiologic reactions to food are immunological(i.e. antibody-mediated).*

● Many other types and triggers and symptoms exist.

– Enzyme deficiency such as lactose intolerance (e.g. GI disruption)

– Goitrogens (e.g. thyroid hormone synthesis suppression)

– Acidic irritants such as coffee or very spicy food (e.g. acid reflux)

– Detoxification impairment such as caffeine (e.g. heart palpitation)

– MSG Reaction (e.g. headache)

– Tyramine sensitivity (e.g. migraine)

– Emotional association (e.g vomiting)

* http://bmb.oxfordjournals.org/content/56/1/34.full.pdf

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Understanding Allergies and Asthma

Part 1

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